Governmental & 3rd Party Insurance Follow-Up Services

Affiliated Healthcare Management Group (AHMG) is aware of the many difficulties that can present at the front lines of a health care provider due to staffing shortages, expertise and high volumes.

In addition, the quickly changing landscape of healthcare delivery and contractual obligations can inundate hospitals with unique challenges to its billing and follow-up capabilities resulting in lower net patient revenue. This situation can intensify when the expertise needed to resolve these complex billing
and follow-up issues are scarce or not available. Triggering undue economic stress on health care provider caused by underpaid and unpaid claims often resulting in unnecessary write offs and lost revenue.

At AHMG, we understand the stress this can cause on an organization as a whole. We strive to provide services that can be utilized by our partners when the need arises. We are staffed with seasoned professionals that are able to institute processes and stabilize governmental and insurance follow-up capabilities to ensure our partners claims are properly addressed in a timely manner. The result is a stable revenue stream on accounts that are challenging to manage due to high volumes, staffing experience, contractual restrictions, and shortage of technological solutions.

Affiliated Healthcare Management Group can perform the following:

  • Review aging accounts to ensure timely filing issues are immediately addressed
  • Follow up on submitted claims using claim tracking and segmentation technology to address inappropriate delays or denials
  • Identify non-performing contractual obligations and provide analytical support to address inappropriate payer behavior
  • Identify patterns of underpayments and provide information for aggregated appeals
  • Identify recurring billing errors and assist Customer in corrective action plan to minimize delays or denials in reimbursement
  • Review all submitted claims in accordance with best practices and industry standards of 7, 15, 21, 30, and 45 day cycles
  • Check appropriate sites for claims status and follow-up
  • Review EOB’s in a timely manner to insure appropriateness of payments
  • Review and rebill denied claims when appropriate and file appeals on inappropriate denials Process allowance for timely filing denials
  • Transfer co-pays, deductibles, co-insurance, and appropriate denials to Self-Pay for immediate follow up

Outcomes:

  • Increased follow-up activity on accounts not timely worked due to high volumes and staffing capabilities
  • Improve billing accuracy by identifying recurring billing insufficiencies which improve accuracy of clean claims
  • Identify inappropriate payer activity and provide feedback for high level payer appeals
  • Lower days in accounts receivable to appropriate industry levels
  • Increase Charge to Cash ratios due to improved collection efforts
  • Lower time to collect and cost to collect
  • Minimize inappropriate write-offs and contractual allowances due to non-payments and underpayments
  • Minimize accounts being referred to Self-Pay for lack of insurance payment to minimize Bad-Debt
  • Increase insurance net revenue
  • Identify opportunities in payer contracts for future negotiations

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